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everett <br /> � <br /> City of Everett <br /> Engineering Depertment <br /> Sewer App�lication and Permit <br /> J � JI�� <br /> �JO. �� �� 1- �. �� � DATE -- <br /> 3ervice Address��� «�• ���-'u .0 dJ Utility Account No. <br /> Billing Address Connection Permit Fee — <br /> City, State, Zip Connection Fee <br /> Owner (Mor[gagorl— Total Fee_ _ <br /> Billing Name_ <br /> Connection By <br /> Address ` Signed _ <br /> c��,���„�•� <br /> Phone � _ _ -- -- <br /> DESc:RIPTION: <br /> Lot <br /> Block_ / � <br /> Division or Addi[ion y <br /> Sewer District <br /> -- — Monthly Sewer Service — <br /> Remarks: <br /> Monthly Sewer Constr. _ <br /> :"o ., )��_C,^� 5� � P� >Q l APProved BY— ----- <br /> / c�v e„�����.��� <br /> — Issued By--_- __—_---- <br /> --- - Connection By_ _ _ ___— <br /> � � <br /> -- Inspeclion By��' ��� � -tt"`"�'� — <br /> Datelnspected—��--�-- --------- <br /> � <br /> SEESKETCH ATTACHED <br />